Provider Demographics
NPI:1346431384
Name:JOHN ED CHAMBERS MEMORIAL HOSPITAL, INC.
Entity type:Organization
Organization Name:JOHN ED CHAMBERS MEMORIAL HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:PEEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-495-2241
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:AR
Mailing Address - Zip Code:72842-0099
Mailing Address - Country:US
Mailing Address - Phone:479-476-2827
Mailing Address - Fax:479-476-2580
Practice Address - Street 1:310 WEST BROADWAY
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:AR
Practice Address - Zip Code:72842-0099
Practice Address - Country:US
Practice Address - Phone:479-476-2827
Practice Address - Fax:479-476-2580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR113073002Medicaid
AR57988OtherBLUE CROSS
AR113073002Medicaid